Probably a stupid question, but what determines how much to give for a fluid bolus? Is there a way to figure it out or something? I was on the L&D unit last week and my patient received an epidural. I know that epidurals can cause your blood pressure to drop which is why they usually give a bolus of fluid, but my nurse set the rate of LR to infuse at 1900mL/hr....that thing was going so fast! It was running for awhile, too...I would say a good 20-25 minutes.
goodstudentnowRN 1,006 Posts Specializes in Telemetry. Has 10 years experience. Oct 6, 2009 There is no set rate. You have to give the bolus while you monitor the blood pressure and other VS on a whole. Maybe this patient pressure was low and so she has to give it very fast and monitor the patient at the same time because on the other hand we do not want the patient to experience fluid overload.
Daytonite, BSN, RN 4 Articles; 14,603 Posts Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience. Oct 6, 2009 You always clarify with the doctor how fast he wants the fluid to infuse.
hypocaffeinemia, BSN, RN 1,381 Posts Specializes in Critical Care. Oct 6, 2009 You always clarify with the doctor how fast he wants the fluid to infuse....While in nursing school at least.
shrimpchips, LPN 659 Posts Oct 8, 2009 Thank you! This is just something that wasn't taught in school, at least not yet...but I've always wondered about it.
J9G2008 195 Posts Oct 8, 2009 Last week, I set the pump after my patient's nurse (I'm a student) put in his IV. 125 mL/hr...working just fine. Then, I take some orthostatic BPs and a little while later, his pump is gunning water into his vein like a machine gun! I gasped, "What happened?" The patient looked at me, laughed, and said, "The nurses came back in because my BP was low when I stood up, and they changed it. Don't worry." I thought I was gonna have a heart attack!
BluegrassRN 1,188 Posts Has 14 years experience. Oct 8, 2009 At my hospital, bolus means as fast as the pump will go, unless the physician specifies otherwise. Now, we're having the issue that our pumps have been changed out. Old pumps would only run fluids at 1000 an hour. Our new pumps will run 4000 an hour. We've been complaining about this and have yet to hear back about an update. When I asked a physician for a rate two nights ago, he was like "I don't know, as fast as it will go!" and when I said, "Okay then, 4000/hr", he was like, Um, I don't know, what do you think? Do those new pumps really go that fast? Okay, then, 4000/hr, I guess, if you think that's okay." Meaning, he didn't know, either.
hypocaffeinemia, BSN, RN 1,381 Posts Specializes in Critical Care. Oct 8, 2009 4000 mL an hour is merely a liter every 15 minutes. If a patient is volume-deprived, that's nothing. I mean, think of the level 1 infusers we can use in ER/ICU for trauma or severely hypovolemic patients. They are capable of infusing up to 30,000 mL/HR. Failing a rapid infuser, I've used pressure bags and/or my bare hands to squeeze in liters of fluid over the course of a few minutes when necessary.
hypocaffeinemia, BSN, RN 1,381 Posts Specializes in Critical Care. Oct 8, 2009 4,000mL/hr sounds pretty dangerous....Why does it sound dangerous to you? It's the rate, not the total volume infused.
BluegrassRN 1,188 Posts Has 14 years experience. Oct 9, 2009 If you have a big vein and hang fluids wide open, a liter will go in in nothing flat. If you have someone crashing and need to get fluids in, 4000/hr is sometimes not fast enough.We don't typically have that level of acuity on our floor. I probably wouldn't run a CHF'ers fluid bolus that fast, but then, we usually are giving them little 250cc boluses, not thousands of ccs. I haven't even set our pumps on the ED/ICU setting...I wonder how fast they would go on that? I'm checking it out the next time I'm at work!
hypocaffeinemia, BSN, RN 1,381 Posts Specializes in Critical Care. Oct 9, 2009 If you have a big vein and hang fluids wide open, a liter will go in in nothing flat. If you have someone crashing and need to get fluids in, 4000/hr is sometimes not fast enough.We don't typically have that level of acuity on our floor. I probably wouldn't run a CHF'ers fluid bolus that fast, but then, we usually are giving them little 250cc boluses, not thousands of ccs. I haven't even set our pumps on the ED/ICU setting...I wonder how fast they would go on that? I'm checking it out the next time I'm at work!Both the plum pumps we had/have and the new Alaris ones we're getting this week unfortunately have a max infusion rate of 999mL/hr. That's not very fast in the scheme of bolusing a patient so we will likely just keep running boluses on gravity with/without pressure bag assistance as needed. I don't worry about fluid overloading a CHF patient if I transduce their CVC for a CVP reading first.
